Suicide is increasing in incidence, especially among middle-aged men. Individual-level studies have lacked sufficient statistical power to investigate suicide in general population samples. In this study, the authors used data from the Health Professionals Follow-up Study to estimate the association between social integration and suicide over 24 years of follow-up. They found a more than 2-fold reduced risk for suicide among men who were socially well-integrated.

Generic prescription drugs made by different manufacturers may vary in color or shape, and switching among these products may interrupt medication use. This cohort and nested case–control study found that variation in the appearance of generic drug pills is associated with lapses in use of essential drugs among patients with cardiovascular disease after myocardial infarction.

The net benefit of cancer screening depends on the patient's age and comorbid conditions, but reliable methods of evaluating when to cease screening are lacking. This modeling study estimated the harms and benefits of screening with mammography, prostate-specific antigen, and fecal immunochemical testing at various ages and comorbid conditions and demonstrates how the presence and severity of comorbid conditions might be included in decisions about cancer screening.

The Patient Protection and Affordable Care Act has resulted in more access to medical care for patients with chronic disease. Nurse-managed protocols for outpatient management of patients with chronic conditions may help meet the increased demand for care. This systematic review identified and evaluated 18 studies and concluded that these protocols can have a positive effect on the outpatient management of adults with chronic conditions.

The Patient-Centered Outcomes Research Institute conducted a merit review in November 2012 that included patients, other stakeholders, and scientists. The authors examined the differences between and relationships among the scores given to research applications by each reviewer group. Patient and stakeholder perspectives and scores differed significantly from those of scientists, but in-person discussion led to closer agreement among reviewers.

Instrumental variable analysis is an increasingly popular method in comparative effectiveness research, but results of such analyses may be biased if the instrument and outcome are related through an unadjusted third variable (an “instrument–outcome confounder”). The authors examined 187 studies that used instrumental variable analysis and concluded that many effect estimates may have been biased by failure to adjust for instrument–outcome confounding.

Ideas and Opinions

Measles incidence in the United States is increasing due to vaccination refusal and disease importation. Yet, many currently practicing clinicians have never seen a case. It is crucial that clinicians become familiar with this potentially fatal disease and apply measures necessary to contain it.

Viral hepatitis is a major public health problem in the United States. In this commentary, officials from the U.S. Department of Health and Human Services address current challenges and opportunities for the control of viral hepatitis and comment on the updated version of the Viral Hepatitis Action Plan for 2014–2016.

This commentary discusses the difficulty in ceasing practices that physicians have come to believe in despite evidence showing that those practices have little value. The authors suggest several approaches to lessen patient dissatisfaction when attempting to discontinue entrenched low-value practices.

Editorials

In this issue, Tsai and colleagues present the results of a longitudinal cohort study of men that examined the relationship of social integration and suicide. The editorialist discusses the study and the recent U.S. Preventive Services Task Force recommendation statement on suicide screening and stresses the importance of a public health approach to suicide prevention.

In this issue, Shaw and colleagues describe how nurse-managed protocols can have a positive effect on the outpatient management of adults with chronic conditions. The editorialists discuss the study and its findings, as well as causes of the shortage of primary care physicians despite an increasing need for their services.